Macular Hole

A macular hole is a small break in the macula, located in the back of the eye within the center of the eye's light-sensitive tissue called the retina. A macular hole involves damage from within the eye, at the junction between the vitreous and the retina itself. Depending upon the degree of attachment or traction between the vitreous and the retina, there may be risk of developing a macular hole in the other eye.

Normal Retina

Affected Retina

How does a macular hole occur?

The eye contains a jelly-like substance called the vitreous. As a person ages, the vitreous becomes thicker and stringier and begins to pull away from the retina. If the vitreous is firmly attached to the retina when it pulls away, a hole can result. In very rare instances, trauma or other conditions lead to the development of a macular hole. In the vast majority of cases, however, macular holes develop spontaneously. As a result, there is no known way to prevent their development through any nutritional or chemical means, nor is there any way to know who is at risk for developing a hole prior to its appearance in one or both eyes.

What are the symptoms associated with a macular hole?

With early macular hole symptoms, people may notice a slight distortion or blurriness in their straight-ahead vision. Straight lines or objects can begin to look bent or wavy. Reading and performing other routine tasks with the affected eye becomes difficult. As a macular hole progresses to stage III, symptoms can include loss of most central and detailed vision or detached retina.

Normal Vision

Vision with a Macular Hole

What are the stages involved with a macular hole?

There are three stages for a macular hole: Foveal Detachment, Partial-thickness hole, and Full-thickness hole. Stage 1, Foveal Detachment, must be treated early or you have a 50% chance of it progressing to stage 2, Partial-thickness hole. The same applies for stage 2, only a higher percentage of stage 2 cases develop into stage 3, Full-thickness hole. Stage 3 affects most of your central and detailed vision and can lead to a detached retina.

Are treatments available for a macular hole?

Yes. Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve vision. The surgery used for macular hole treatment is called a vitrectomy, During a vitrectomy, the vitreous gel is removed to prevent it from pulling on the retina. It is then replaced with a bubble containing a mixture of air and gas or refilled with saline solution. The bubble acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals and the saline solution acts in the same way. Macular hole surgery is performed under local anesthesia and often on an outpatient basis, meaning you will go home the day of the procedure.